Fichas
GI part 2
Fichas del conjunto (65)
- 1What are accessory organs to the digestive system?Liver, gallbladder, & pancreas
- 2What is the largest visceral organ in the body?Liver
- 3How many lobes does the liver have?2 large lobes (R lobe & L lobe)
2 small lobes (caudate & quadrate) - 4How much CO does the liver recieve?25%
- 5What are functional units of liverLobules
- 6Where does the liver receive blood from?Dual blood supply - venous portal supply & arterial blood supply
- 7Explain how the liver receives venous blood1.) Venous blood via hepatic portal vein comes from digestive tract & GI organs
2.) Carries nutrients & toxic materials
3.) Supplies 75% of O2 to liver
4.) Venous outflow carried by hepatic veins → empties into vena cava - 8How much blood can the liver hold?Liver can hold 500 – 1000mL of blood
- 9What can cause an increase in accumulation of blood in the liverRight heart failure → ↑ vena cava pressure → ↑ accumulation of blood in liver
- 10Metabolic Functions of the LiverProduces bile
Metabolizes drugs and hormones
Eliminates bilirubin
Synthesizes proteins, glucose, clotting factors (including albumin)
Stores vitamins and minerals
Changes ammonia to urea
Converts fatty acids to ketones
Degrades excess nutrients - 11Why does the liver secrete bile? How much does it secrete?For digesting fat, absorbing fats and vitamins from the intestine. Produces 500-600 mL/day.
- 12What does bile contain?Water, bile salts, bilirubin, cholesterol, other metabolism by-products
- 13What do bile salts aid in?Emulsifying fats
- 14What is Cholestasis?decrease in bile flow → accumulation of bilirubin, cholesterol and bile salts in blood
- 15What are symptoms of Cholestasis?dark urine, jaundice, steatorrhea (fat within feces), itchy skin
- 16What is bilirubin?Bilirubin = final product of breakdown of heme (from old RBCs)
eliminated through bile → small intestine → feces - 17What is Jaundice? How is it caused?1.) Results from high levels of bilirubin in blood
2.) Causes yellowish discoloration of skin and deep tissues
3.) Occurs when imbalance between synthesis and clearance of bilirubin - 184 causes of Jaundice1.) Excessive destruction of RBCs
2.) Impaired uptake of bilirubin by hepatocytes
3.) Decreased conjugation of bilirubin
4.) Obstruction of bile flow (cholestasis) - 19What is Hepatitis?liver inflammation caused by hepatotropic viruses
- 20What are the different types of Hepatitis? How do they differ?Hepatitis A, B, C, E (all cause acute hepatitis) but differ in:
1.) mode of transmission
2.) Incubation period
3.) Mechanism, degree and chronicity of liver damage
4.) Ability to evolve to carrier state - 21What are 2 mechanisms of liver injury?Direct cellular injury – caused by virus in cell
Immune response against viral antigens - 22What does Hepatitis cause cells to do?Hepatitis causes cell to express surface antigen – recognized by T-cells to trigger cytotoxic killing & apoptosis
- 23Common Symptoms & Signs of Hepatitis1.) hepatomegaly
2.) ↑ transaminase in blood (as damage progresses) – AST & ALD
3.)Jaundice – bilirubin in blood stream (damage to bile ducts causes leaking) - 24Hepatitis ASmall unenveloped RNA virus
Almost always acute (doesn’t progress to chronic hepatitis) - 25Transmission of Hep ATransmission: ingestion (fecal-oral route)
- 26Pathophysiology of Hep APathophysiology: replicates in liver; excreted in bile; shed in stool
- 27Dx & Tx of Hep Aserologic testing (IgM anti-HAV)
Prevention: Hep A vaccine
Tx: supportive care - 28Hep BDNA virus. Can be acute or chronic
- 29Hep B transmissionparenterally
- 30Hep B Dx & Txserologic testing (HBsAg)
Prevention: Hep B vaccine
Tx: supportive care; liver transplant if fulminant disease - 31Hep CRNA virus. Acute & Chronic types
- 32How is Hep C transmittedBlood, needle-sharing, sex
- 33How to Dx & treat Hep CDx: PCR assay for HCV RNA
Prevention: avoid high-risk behavior (no vaccine)
Tx: antiviral therapy; liver transplant (leading reason for liver transplant) - 34Where is alcohol mostly metabolized?In the liver
- 35How is acetaldehyde made?ETOH → ADH → acetaldehyde
- 36What is acetaldehyde?Acetaldehyde is a toxic & reactive molecule
Leads to radical formation (ROS)
Impedes mitochondrial electron transport system - 37Acetaldehyde dehydrogenase (ALDH) breaks down what into whatADH → acetate
- 38What are 3 stages in ETOH Liver Disease?1.) Fatty Liver Disease
2.) Alcoholic Hepatitis
3.) Alcoholic Cirrhosis - 39Explain fatty liver diseaseAccumulation of fat in hepatocytes – steatosis
Liver turns yellow and enlarges
Reversible if alcohol intake stops - 40Explain Alcoholic hepatitisCommon in binge drinkers
Inflammation and necrosis of liver cells
Hepatic tenderness, pain, anorexia, nausea, fever, jaundice, ascites, liver failure - 41Explain Alcoholic CirrhosisEnd-stage liver disease
Fine, uniform nodules on surface of liver
Nodules grow as disease progresses → compress hepatic veins → portal hypertension and cholestasis - 42What is considered end-stage chronic liver disease?Cirrhosis
- 43What is Cirrhosis? What is it caused by?Function liver tissue replaced by fibrous tissue
Caused by multiple disease processes - 44Pathophysiology of CirrhosisHepatic fibrosis
Regenerative nodules – classic sign of cirrhosis
Between nodules is fibrotic tissue and collogen
Compresses portal vein (portal hypertension) → fluid into peritoneal cavity → ascites
Hepatoportal shunt - 45Complications of CirrhosisPortal hypertension → ascites, varices
Hepatic encephalopathy (increase in ammonia blood levels)
Jaundice
Coagulopathy - 46Signs & Symptoms of Cirrhosis (this is more w/o hx of ETOH)1.) Palpable firm liver
2.) Weight loss
3.) Anorexia - 47How to Dx Cirrhosis1.) Liver blood test (AST,ALT)
2.) Coagulation Tests
3.) Imagining to asses for nodules & fibrosis
4.) Liver biopsy if you can't tell by imaging - 48How to Tx Cirrhosis1.) Supportive care
2.) Stop injurious agent
3.) TIPS if portal hypertension is refractive to other tx - 49What is portal hypertension?Elevated pressure in the portal vein
- 50What causes portal hypertensionCause: increased resistance to hepatic blood flow
1.) Thrombosis
2.) compression due to cancer growth
3.) Severe right-sided heart failure
4.) Fibrosis from cirrhosis (major cause) - 51Complications of portal hypertension1.) Ascites
2.) Splenomegaly
3.) Hepatic encephalopathy
4.) Formation of portosystemic shunts → esophageal varices - 52What is in the hepatobiliary system?Gallbladder; hepatic duct; common bile duct
- 53What is the Gallbladder & what does it do?Gallbladder is pear-shaped muscular sac
Stores and concentrates bile - 54What happens when food enters the intestine?triggers gallbladder to contract and open the sphincter of bile duct → moves bile into the duodenum
- 55What is Cholelithiasis? What is it caused by?Gallstones. Caused by precipitation of substances of bile (usually cholesterol & bilirubin)
- 56What are gallstones formed from?Formed from:
Abnormalities in the composition of bile (↑ cholesterol)
Stasis of bile - 57Signs & symptoms of Gallstonesindigestion; jaundice; pain (URQ) with abrupt onset
- 58Dx & Tx of GallstonesDx: U/S
Tx: laparoscopic cholecystectomy - 59What kind of organ is the pancreas?endocrine and exocrine
- 60What is the pancreas' endocrine function?secrete digestive enzymes into ducts that empty into the bile duct at the hepatopancreatic ampulla and empties into duodenum
- 61What do pancreatic secretions contain? When do the secretions become active?Proteolytic enzymes; pancreatic amylase; lipases
Don’t become active until in the intestine - 62What is Acute PancreaticReversible inflammation of the pancreatic acini (cells of the pancreas’ lobules).
Caused by the premature activation of the pancreatic enzymes - 63Pathophysiology of Acute Pancreatitispremature activation → autodigestive injury → damage tissue activate inflammatory cascade → produce cytokines → inflammation and edema
- 64Signs & Symptoms of Acute Pancreatitistachycardia; hypotension; ↑ C-reactive protein on labs
- 65Dx & Tx of Acute PancreatitisDx: need two of the three features (abdo pain; ↑ serum amylase/lipase; imaging showing acute pancreatitis
Tx: supportive – fluid resuscitation, pain control and nutritional support
Avoid stimulation for secretion of enzymes (withhold food)
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- Resp Therapy Pathophysiology Fichas sobre GI part 2, creado por Kyha Avery el 31/10/2023.
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- Kyha Avery
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